Physical activity in any form is good, but when it comes to maintaining bone health, research suggests moderate exercises like walking and water aerobics are not enough.
A recent study by Deakin University researchers finds that a variety of weight-bearing exercises is necessary for both bone and muscle health, to help reduce risk of falls, fractures and osteoporosis in older adults.
“Your bones are there to support your muscles to create movement, so if you have low bone strength, you’re at increased risk of having a fracture,” explained Professor Robin Daly to Community Care Review.
Around 90% of older people who fall over end up with osteoporotic fractures. In 2011 more than a million Australians were diagnosed with osteoporosis and nearly five and a half million had osteopenia, putting them at risk of fragility fracture.
With an aging population, it’s estimated that by 2021, fractures will occur every three and a half minutes and three million Australians will have osteoporosis-related conditions, leading to a downward spiral of poor health and quality of life along with mounting health care costs.
Prevention is therefore critical.
Daly’s team created an 18-month community program called Osteo-cise: Strong Bones for Life for community dwelling adults aged 60 or older, providing 12 months of structured, multi-modal exercises along with education and behaviour change modules.
Half of the 162 volunteers were randomised to take part in group fitness sessions at a health and fitness centre three times a week. The other half were given information about osteoporosis and both groups received vitamin D and calcium supplements.
After 12 months, those taking part in the Osteo-cise program had vastly greater improvements in bone density, muscle power, strength and balance. Daly says other programs tend to improve one of these but addressing them all is important to prevent risk of falls and fractures.
Their multifaceted program focussed on weight-bearing exercises and a method of resistance training that optimises muscle power – the body’s ability to do fast and forceful movements which is needed for balance, mobility and reaction time to prevent falls.
“Such rapid and forceful movements also place high loads on bones which may help to improve their strength,” co-author Dr Jenny Gianoudis told The Senior.
Daly explains, “Bones are alive and they like to be stressed, so when you do activities that put strain on them, the bone cells get excited and form new cells.”
As noted by America’s National Institute of Health, the best exercises to stimulate bone cell growth involve weight-bearing and resistance.
Weight-bearing exercises such as hiking, jogging, climbing stairs, playing tennis, skipping, stair climbing and dancing make you work against gravity.
Resistance training for bone health involves weights, particularly focussing on the muscles around the hips and spine during fast, short sessions twice a week rather than one long session.
Gentler exercises such as swimming, walking and riding can help strengthen muscles and are good for heart health, but are not as good for bones.
It’s important to build up to more rigorous workouts under trained supervision, and work to a level that suits the individual.
And it’s never too late; even people with limited range of movement and dementia can derive significant benefits from physically tailored exercise programs.
Many people who are living longer after a sedentary lifestyle are paying the price. The diseases osteoporosis and sarcopenia are on the rise, and their underlying biological similarities and common risk factors are creating a new syndrome: osteosarcopenia.
This syndrome exacerbates each disease’s associations with high risk of frailty, falls, fractures, hospitalisation and mortality; indeed, a study confirmed that osteosarcopenia is linked with poorer physical function than sarcopenia alone.
Early diagnosis and intervention for this “hazardous duet” are imperative, so here’s what to know.
Osteoporosis affects more than 60% of Australians over 50 years. It happens with aging when bone tissue starts deteriorating, resulting in porous bones and increased risk of fracture – even with minor falls. It can be diagnosed with a bone mineral density scan.
Sarcopenia, on the other hand, refers to accelerated loss of skeletal muscle mass and strength with aging. Affecting around one in three older adults, it can be harder to detect – especially if a person is overweight. Handgrip is typically used to measure muscle strength and gait to assess physical performance.
Bones and muscles both release hormones that impact the metabolism and functions of other tissues, and crosstalk with fat cells – together these three groups are the biggest constituent of connective tissue.
When muscle and bone tissues break down, they are typically infiltrated with fat cells which creates toxicity and inflammation and interferes with the crosstalk between them.
The only way to diagnose osteosarcopenia is with combined detection of each disease.
A history of falls and/or fractures should sound warning bells. Shortened stature is also a clue to fractures of the vertebrae due to osteoporosis. Muscle weakness and wasting can point to sarcopenia, and genetics play a role in both conditions.
People with these risk factors should be regularly screened for each disease, and experts agree that all postmenopausal women over 65 should have bone mineral density scans regardless.
Factors that lead to high risk of osteosarcopenia include older age, being female, endocrine disorders, sex steroids, low protein intake, smoking, inadequate dietary calcium intake, low vitamin D levels, and minimal mobility and function.
It is better to treat osteosarcopenia as one condition, using an integrated approach, rather than the two contributing diseases separately.
Inactivity is a primary, modifiable cause of muscle wasting and bone density loss, as the health of both bones and muscles relies on mechanical stimulus. Resistance training – increasing muscle strength – is most important.
Regular weight-bearing and muscle-strengthening exercises that target agility, strength, posture and balance have demonstrated benefits and are recommended at least three times a week for 20 minutes or more.
Protein is vital for bone and muscle and is recommended at more than 0.8 mg/kg body weight per day. Calcium and vitamin D also have dual benefits for bone and muscle; together with protein they can help reduce falls, fractures and disability.
Regular activity and a healthy diet with adequate nutrition are also the most effective ways to prevent age-related deterioration of bone and muscle and retain independence and optimal quality of life.
One of our staff recently spoke with someone whose father is in an aged care facility. They discovered he had a hairline fracture in his hip – about a week after it happened. The nurse accidentally dropped him when she was helping him out of bed, and it wasn’t reported.
Around one in three older adults suffer from falls, and up to 60 percent will suffer an injury. Three times more people tumble in long-term aged care.
Most injuries are superficial cuts, grazes, bruises and sprains. Some are more serious. Falls cause 40 percent of injury-related deaths in older adults. Hip fractures are the most serious and costly fall-related injuries, resulting in 19,000 hospital admissions for older Australians from 2011 to 2012.
More broadly, falls – and fear of falling – can impact independence and quality of life. But it’s not a cross lotto. Older people can reduce their risk of falls with nutrition and exercise.
Assessment tools can predict risk of falls, to help tailor prevention strategies. These tend to assess physical capacity like mobility, balance, strength and gait. But nutrition status is also a key predictor for likelihood of falling and the gravity of injuries.
Malnutrition and low body weight result from depleted protein and energy stores. This carries multiple adverse outcomes including bone loss and fragility, poorer movement coordination, slower reaction time and diminished muscle strength – all of which increase risk of falling.
Low calcium and vitamin D impact bone health and risk of falls. Low vitamin K also increases bone fragility. Poor eyesight can compound propensity to fall, also impacted by nutrition status. Low levels of vitamins A, C and E contribute to weak vision.
Insufficient vitamin B12 and folic acid can reduce nerve function in extremities, and in the brain lead to confusion. Dehydration, a common problem in older adults, can also cause delirium, as well as constipation and low blood pressure; all increasing fall risk.
Providing a healthy, tasty diet high in protein from eggs, dairy, fish, chicken, nuts and legumes and a variety of foods from the core food groups is an important step towards preventing nutrient depletion and associated risk of falling.
Regular physical activity is important to reduce age-related loss in muscle mass and bone density. Recently, the SUNBEAM trial (Strength and Balance Exercise in Aged Care), tested a program of individually tailored physical activity in aged care.
The program reduced falls by 55 percent, larger than any other study to date according to lead investigator Jennie Hewitt, physiotherapist from Feros Care and PhD candidate at the University of Sydney.
Over 200 aged care residents from 16 facilities in New South Wales and Queensland took part – half of them were randomised to do the program and the other half continued normal activities.
Participants in the program engaged in 50 hours of group-based resistance (strength) training and balance activities over 25 weeks, then a six-month maintenance period.
Not only did falls decrease dramatically in the exercise program group, but participants had considerably better balance and mobility. Some found the enhanced independence life-changing, and rejoiced at being able to go out with their families.
It’s not just about falls; healthier lifestyles and greater mobility have positive ripple effects for happy aging.
Like many confusing nutrition messages, some claim too much protein is bad for bone health. What is the scientific consensus, and what does this mean for people with or wanting to avoid osteoporosis? What other nutrients are important? First, let’s look at osteoporosis.
All living tissues, including bones, are constantly getting rid of old cells and generating new cells. With aging, however, the rate at which bones are replaced slows down.
Osteoporosis, meaning porous bones, happens when too much bone is lost and not enough produced, resulting in reduced bone mineral density and a fragile skeleton easily prone to fractures. It is different to osteoarthritis, which results from degenerated cartilage in the joints.
Sarcopenia – age related muscle loss – is closely related to osteoporosis, and they are impacted by similar factors. Bone health is therefore considered not just a skeletal problem, but a musculoskeletal problem.
Osteoporosis is a significant global concern – one in three women and one in five men over 50 may suffer from a fracture caused by osteoporosis. But there are ways to prevent and even treat it, including physical activity, sunshine and good nutrition.
Calcium is commonly known to be important for bones, and most know vitamin D is important too – it helps bones absorb calcium. Perhaps less well known is that magnesium may also prevent bone turnover and improve bone mineral density.
For good bone health, the National Osteoporosis Foundation recommends dairy products, fish (canned fish like sardines with bones for calcium; oily fish like salmon, mackerel, tuna and sardines for Vitamin D), and a variety of fruit and vegetables for their mineral content (calcium, potassium, magnesium), vitamin C and vitamin K.
Protein is not only a key constituent of muscle, it comprises about 50% of bone volume and around 30% of bone mass. It is also associated with increased production of insulin-like growth factor, which helps make bones, and better intestinal calcium absorption.
Some studies suggest eating too much protein increases calcium excretion in the urine, leading to concerns about high protein intake for bone health. This is thought to occur because protein increases the body’s acidity, so calcium – an alkaline mineral – is released to restore balance.
However numerous studies have refuted this; in fact when calcium intake is adequate, higher protein diets are linked with higher bone mass and less fractures. Any loss may also be offset by increased calcium absorption.
Furthermore, low protein intakes (<0.8g/kg per day) reduce calcium absorption which in turn stimulates the release of parathyroid hormone to tell bones to release calcium and restore its balance in the blood.
What are good protein sources for bone health? Some studies have suggested higher meat consumption increases calcium excretion, but others have refuted that. Soy protein could reduce insulin-like growth factor so may not be a good choice.
Fish, chicken and eggs provide protein. Dairy foods are good protein and calcium sources. Legumes are a good source of protein and other nutrients but should be well soaked then cooked in fresh water to reduce phytates (which could interfere with calcium absorption). Similarly, nuts provide protein along with fibre and other nutrients.
To maintain a healthy acid-alkaline balance, other dietary factors also need consideration. In particular, plant foods like fruit and vegetables abound in potassium and other alkaline minerals, so eating more of these would help prevent bones’ need to release calcium.